Cauda equina syndrome: a review of the current clinical and medico-legal position
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Alan Gardner • Edward Gardner • Tim Morley
- چاپ و سال / کشور: 2010
Description
Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50–70% of patients have urinary retention (CES-R) on presentation with 30–50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.
Eur Spine J (2011) 20:690–697 DOI 10.1007/s00586-010-1668-3 Received: 11 August 2009 / Revised: 22 November 2010 / Accepted: 15 December 2010 / Published online: 31 December 2010
